Provider Demographics
NPI:1104942507
Name:ARKOUDAS, WADE (DDS)
Entity type:Individual
Prefix:
First Name:WADE
Middle Name:
Last Name:ARKOUDAS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2112 N HILL FIELD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-4023
Mailing Address - Country:US
Mailing Address - Phone:801-774-0770
Mailing Address - Fax:
Practice Address - Street 1:2112 N HILL FIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4023
Practice Address - Country:US
Practice Address - Phone:801-774-0770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT621630899231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry